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Last Updated: 10/8/2013  

Primary Immune Thrombocytopenia

Diagnosis
  • Primary ITP is a diagnosis of exclusion. Use history, physical exam, and laboratory testing to rule out secondary causes of thrombocytopenia.

  • The secondary causes of ITP include antiphospholipid syndrome, drug side effects, infections (CMV, H. pylori, HCV, HIV, varicella zoster), lymphoproliferative disorders, bone marrow transplant, vaccination side effect, and systemic lupus erythematosus.

  • Carefully evaluate patients for signs or symptoms of bleeding.

Therapy
  • Advise patients to abstain from drinking alcohol; avoid contact sports and other recreational activities associated with increased risk of trauma; and avoid aspirin, NSAIDs, and anticoagulants unless otherwise advised by a physician.

  • Corticosteroids are the initial therapy of choice.

  • Splenectomy is recommended for patients with ITP for whom corticosteroid-based therapy was ineffective.

  • Vaccinate patients against S. pneumoniae, N. meningitidis, and H. influenzae type b at least 2 weeks prior to splenectomy.

  • Close follow-up is needed to check for evidence of bleeding or recurrence of thrombocytopenia.

DOI: 10.7326/d340
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Ronit Simantov, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Donald M. Arnold, MD, MSc was a consultant for Amgen; received speaking honoraria from Amgen, GlaxoSmithKline, Hoffman-LaRoche and Talecris; was a member of advisory boards for Amgen and GSK; received research funding from Hoffmann-LaRoche, Amgen and GSK.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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